What is a permanent tattoo?
Tattooing involves introducing pigments and dyes into the skin to obtain a permanent design by pricking the skin with a dermograph. This practice has become increasingly popular over the last twenty years.
The realization of a tattoo is not without risk
What are the dangers of getting a tattoo?
The tattoo realizes an effraction of the cutaneous barrier and a rupture of the small vessels of the skin. After that, the presence of these foreign bodies in the skin can lead to allergic reactions or localization of skin-specific problems specific to an individual.
During the tattoo session, the needles pierce the skin and induce a breach in the skin barrier. This small wound that will heal in a few weeks can be the door of entry to bacterial infections, particularly with Staphylococcus. Fortunately, these infections are rare, and in most cases, they develop favorably within a few days. The tattooist regularly disinfects the skin during the session. During the healing period, the client must clean with water and soap several times the tattoo as of the end of the session. The soap is an excellent disinfectant that prevents a cutaneous infection like bacterial folliculitis or furuncles.
Severe infections with classical germs like Staphylococcus or atypical germs (mycobacteria) occurred when the tattooist worked in improper hygiene conditions or when the customer did not respect the aftercare recommendations.
Finally, viral warts can sometimes appear on tattoos without really knowing why. They are probably warts present before the tattooing, but not visible to the naked eye or not recognized by the tattooist, and spread than on the traces of the tattoo.
Getting a tattoo involves bleeding during the session with a potential risk of contamination by certain viruses transmissible by the blood, such as hepatitis B, HIV, and especially hepatitis C. Cases of infections mainly for hepatitis C were reported many years ago after getting a tattoo. The contamination was due to the absence of proper hygiene conditions during the session. It happened when the tattoo artists reused material or the same needles on several patients without sterilizing them. Currently, “professional” tattooers use disposable needles with single-use or sterilizable material. These precautions make exceptional, not to say impossible, the infections by the virus of the hepatitis C in dedicated salons.
Allergic reactions to tattoo inks
It is the most frequent complication after tattooing. The reactions involve itching, swelling – sometimes after solar exposure – and more or less acute lesions.
Usually, only one color is affected (red, which is possible for all other colors). These reactions are unpredictable and can occur from a few weeks to more than 40 years after the tattoo. These reactions are still, to this day, unexpected.
The treatment of these allergies passes by the application of local corticoids. But, these treatments are disappointing because the ink is always present on the skin. The removal of the tattoo by laser or surgery is sometimes essential.
Making a “test area” of tattooing on a hidden skin spot is useless. No allergy test before tattooing is of any interest to detect an allergy to tattoo ink.
Regulation of the composition of tattoo inks has started at the European level. It could allow in the future to limit this type of complications and to better advise a customer in case of known allergy to a component.
For the moment, in case of pre-existing allergy to tattoo ink (to a given color), it is better to avoid the color whatever the brand of tattoo ink because standard components are used in different inks.
Some chronic dermatological diseases can be localized preferentially on zones of traumatism like tattoos, such as psoriasis, lichen plan, cutaneous lupus, sarcoidosis, or vitiligo. It is recommended for people suffering from these diseases to avoid getting a tattoo or, at least, not getting a tattoo when the disease is active (lesions that increase in number and/or size) or during active treatment. Tattooing “next to” the lesion does not help prevent a possible outbreak because skin diseases affect the whole body, even where the skin appears “healthy.”
What are the risks of tattooing in case of atopic eczema?
The complications are the same as the previous ones (infections, allergic reactions, …).
There are no specific complications specific to atopic dermatitis after getting a tattoo. An atopic eczema flare-up may occur after getting a tattoo, on the tattoo area, or elsewhere on the body.
A first tattoo can be a source of apprehension or stress for the patient, which can theoretically aggravate or promote a flare-up.
The application of corticoids and moisturizing creams is possible in case of eczema plaque on a healed tattoo.
What are the pieces of advice to follow?
Be sure of your decision
Consider your decision to get a tattoo and avoid “impulsive” tattoos. Tattooing is permanent, and, despite improvements in tattoo removal techniques, laser tattoo removal is not 100% effective and is long, painful, and costly. Tattoo removal always comes with a scar.
Choosing your tattoo artist
Choose a licensed professional tattoo artist working in a dedicated salon.
Avoid getting tattoos at home because they have an increased risk o infection and mediocre aesthetic results (which is a source of regret).
Respect the care after the tattoo
Respect all the aftercare advice given by your tattoo artist. Each tattooist has his habits, but there is standard advice after getting a tattoo: no swimming pool, no seawater, and no direct sunlight on the tattoo while it is healing. Wash with warm water and soap 2 – 3 times a day. There is no indication to apply a disinfectant or an antibiotic cream systematically.
Are there any additional precautions if I have atopic eczema?
Prepare your atopic skin well before tattooing with good skin hydration, and avoid getting a tattoo if your atopic eczema is active.
To warn the tattoo artist about possible allergies, particularly disinfectants or cosmetic creams. Ensure the healing creams sold or advised by the tattoo artist are safe for eczema. No artist makes a tattoo on skin lesions. In case of an eczema lesion on a zone planned for a tattoo, it is necessary to suspend the session and consult a dermatologist to take advice or adequately treat the area, particularly by moisturizing creams or dermocorticoids. The tattoo will be done after stopping corticoids or tacrolimus/pimecrolimus.
Discuss with your dermatologist the wish for a tattoo to know the best time to get a tattoo.
In the case of immunosuppressive treatment such as methotrexate, azathioprine, or cyclosporine, it is necessary to discuss with the prescribing doctor the wish or a tattoo.
What if I have one or more contact allergies?
As mentioned above, if you are allergic to disinfectants or cosmetic creams, you should check with the tattoo artist to ensure that he does not apply a product to which you are allergic.
Concerning the allergies to metals (nickel, cobalt, chromium…), the maximum concentrations allowed for impurities such as metals in tattoo inks and permanent make-up (metallic salts) are defined by a resolution of the Council of Europe in 2008 (ResAP (2008)1).
Unfortunately, there is no specific recommendation for people with nickel allergies.